Internalized Stigma in Adolescents With Major Depressive Disorder and Their Parents: Associations With Functioning,Help-Seeking,Beliefs,and Social Support

Abstract

Background:

Adolescents with major depressive disorder (MDD) often internalize stigma, undermining functioning and help-seeking. Parents may likewise internalize stigma about their child’s condition, shaping family dynamics and care engagement.

Aim:

To examine internalized stigma in adolescents with MDD and their parents, and its associations with adolescent depressive severity, perceived social support, beliefs about mental illness, help-seeking attitudes, and adolescents’ global functioning.

Method:

Cross-sectional tertiary-clinic study (July–October 2023) of 55 adolescents (12–18 years) with DSM-5 MDD and one parent each (n = 55); 81.8% of adolescents were female. Adolescents completed BDI, SSDS, ISMI-CA, BTMI, MSPSS, and ATSPPH-SF; clinicians rated GAF. Parents completed BDI, P-ISMI, BTMI, and ATSPPH-SF. Group comparisons, correlations, and multivariable linear regression were used.

Results:

Parents of adolescents with a suicide attempt or non-suicidal self-injury (NSSI) reported higher P-ISMI (higher alienation and stereotype endorsement; for NSSI also higher perceived discrimination and social withdrawal). Greater adolescent depressive severity correlated with higher self-stigma across SSDS subscales, which related to poorer GAF and lower MSPSS. Higher parental depressive symptoms correlated with higher P-ISMI. Adolescents’ social-inadequacy self-stigma was associated with parental social withdrawal. Help-seeking attitudes were more positive with increasing adolescent age and education. Longer psychiatric follow-up related to higher parental stereotype endorsement and social withdrawal, whereas higher parental education related to lower perceived discrimination. In multivariable models, adolescent depressive symptoms predicted poorer functioning, and parental depressive symptoms explained substantial variance in parental internalized stigma, whereas other predictors showed more limited independent effects.

Conclusion:

Internalized stigma in adolescents with MDD and their parents is strongly associated with clinical burden and functioning in this clinical, predominantly female sample. Findings underscore internalized stigma as a family-embedded, interconnected process and suggest that integrating family-inclusive, stigma-informed care that strengthens social support may improve youth depression management and treatment engagement.